A9507 Insurance Policy Changes

HCPCS A9507 is officially defined as "Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries." HCPCS A9507 is referenced in 3 tracked payer policy changes from Aetna, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS A9507 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 14, 2026Medium impact
Tumor Scintigraphy (CPB 0168, reviewed 2026-03-27)
Aetna considers ProstaScint medically necessary for pre-operative staging of newly diagnosed, biopsy-proven prostate cancer thought to be clinically localized with a moderate to high probability of occult extra-prostatic metastasis, and for staging after prostatectomy or radiation therapy when there is high suspicion of residual cancer or recurrence. The policy also covers Oncoscint for occult colorectal carcinoma and recurrent ovarian cancer, CEA-Scan with CT for recurrent or metastatic colorectal cancer, OctreoScan for neuroendocrine tumors bearing somatostatin receptors, I-131 MIBG imaging and therapy for neuroblastoma and pheochromocytoma or paraganglioma, lymphoscintigraphy with sentinel lymph node biopsy for the cancers it lists, and Lymphoseek (technetium Tc 99m tilmanocept) for locating lymph nodes in members with breast cancer or melanoma who are undergoing surgery to remove tumor-draining lymph nodes. Azedra (iobenguane I-131) is considered medically necessary for adults and adolescents aged 12 years and older with unresectable pheochromocytoma or paraganglioma that has spread beyond the original tumor site and requires systemic anti-cancer therapy. For all other indications, the policy considers these procedures experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Radioimmunoscintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for Prostate Cancer
This policy was last reviewed 06/24/2024 with no changes. Radioimmunoscintigraphy using indium 111 capromab pendetide (ProstaScint) is considered investigational for the evaluation and management of individuals with prostate cancer. The FDA approved this agent in 1996 through the biologics license application process as a diagnostic imaging agent for newly diagnosed, biopsy-proven, clinically localized, high-risk prostate cancer and for post-prostatectomy patients with a rising PSA and a negative or equivocal standard metastatic evaluation. Investigational codes listed are CPT 78800 through 78804 and HCPCS A9507.
Premera Blue Cross · Identified Jun 18, 2026Medium impact
Medical Policy and Coding Updates - October 2019
This medical policy and coding update for WA and Alaska lists changes with effective dates from September 1, 2019 through January 3, 2020. Several medical policies state that a service may be considered medically necessary when criteria are met, while others are considered investigational, including irreversible electroporation (NanoKnife System) and implantable peripheral nerve stimulation for chronic pain. Coding updates effective October 1, 2019 add codes that now require review for medical necessity and prior authorization, including J1303, J9204, J0593, J9118 and Q5116.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect HCPCS A9507?

There are 3 tracked policy changes affecting HCPCS A9507, including updates from Aetna, Blue Cross & Blue Shield of Mississippi, Premera Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS A9507?

Payers that have issued tracked updates for HCPCS A9507 include: Aetna, Blue Cross & Blue Shield of Mississippi, Premera Blue Cross.

How do I get notified when HCPCS A9507 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS A9507. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS A9507?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Tumor Scintigraphy (CPB 0168, reviewed 2026-03-27)

Radioimmunoscintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for Prostate Cancer

Medical Policy and Coding Updates - October 2019

What insurance policy changes affect HCPCS A9507?

Which payers have updated policy for HCPCS A9507?

How do I get notified when HCPCS A9507 policy changes?

Why do payers change policies for HCPCS A9507?